Treating Degenerative Scoliosis in New Jersey
Degenerative bone disease can affect the structural integrity of the spine. If the degenerative process causes a curve to form anywhere along the spine, the condition is known as degenerative scoliosis. This may occur during adulthood and is referred to as adult-onset scoliosis.
At Centers for Neurosurgery, Spine, and Orthopedics, patients with scoliosis and any cause of spinal deformity will be treated by renowned scoliosis surgeons trained in neurosurgery and orthopedic spine surgery. The scoliosis team also includes physical therapists and pain management doctors. Based on the severity of the symptoms and the degree of scoliosis, together they provide a comprehensive treatment plan for each patient. Find out more about adult scoliosis, how it is diagnosed, and the state-of-the-art treatments available.
Spinal Curvature and Degenerative Scoliosis Causes
The spine is made up of 33 vertebral bones which interconnect via four facet joints at each level of the spine. These joints allow movement of the back, such as bending or turning of the neck, thorax, lower back, and pelvis. Between each vertebra is a gelatinous disc that absorbs downward gravitational pressure, providing cushioning between the bones.
From anterior to posterior, the normal curve of the spine allows for optimal distribution of mechanical forces and body weight. When viewed from the side, the upper back has a C-shaped curve while the neck and lower back both form a reverse C-shaped curve. The three regions of the spine at which there is such a curve are:
Neck (cervical spine)
Upper back (thoracic spine)
Lower back (lumbar spine)
When viewed from behind, a healthy spine should appear as a straight column. Whereas a spine affected by scoliosis has a lateral (side-to-side) curve. This spine deformity is often described as an “S-shaped curve. A spine with scoliosis also may be rotated or twisted, in addition to having formed an “S-shaped” curve.
As the human body ages, most do not develop a deformity. But as the bones age they begin to show signs of wear and tear. If a spinal deformity were to begin to become symptomatic or develop, it typically affects several levels of the spine.
What causes some patients to develop scoliosis later in life versus congenital causes is unknown. Some degenerative diseases that can cause scoliosis to form later in life or to become symptomatic later in life include:
Pre-Existing Asymptomatic Scoliosis
Minor degrees of scoliosis cannot be detected during a routine physical exam. It can however be detected upon X-ray. Minor degrees of scoliosis may never become symptomatic or with an injury or the aging process, the curvature causes additional strain that can no longer be supported by the surrounding vertebral bones, placing stress on the surrounding tissue which causes the adult patient to experience discomfort.
Spinal Arthritis
Arthritis of the spine typically develops in patients over age 40. Osteoarthritis is a type of degenerative arthritis that is the most common. When it occurs in the spine, it is referred to as spondylosis.
There are other types of arthritis, such as rheumatoid and psoriasis, but the prevalence is significantly less. In any type of arthritis, as the joints and ligaments degenerate, it becomes increasingly difficult for the vertebrae to maintain proper alignment, making them more prone to symptomatic deformity, such as scoliosis or spondylolisthesis.
Degenerative Disc Disease
Degenerative disc disease is also associated with arthritis of the spine. Part of the normal aging process is for the gelatinous discs between each vertebra to thin, causing an individual to lose up to an inch in height.
Similar to spondylosis, disc degeneration can lead to an asymmetrical curvature of the spine, which causes symptoms of back pain along with other symptoms. In diagnosing the cause of back pain, the team at Centers for Neurosurgery, Spine & Orthopedics takes the patient’s likelihood of developing a spine condition into account. Risk factors for developing arthritis, spondylosis, or degenerative disc disease that may lead to scoliosis include:
- Age
- Gender
- Congenital diagnoses
- Comorbidities
- Physical labor
- Weight/obesity
- Previous injury, trauma, or health issues
- Family history of joint or cartilage issues
- Tobacco use
Degenerative scoliosis typically begins at age 50 but can develop sooner after an injury or trauma. In most cases, scoliosis is the result of mild, idiopathic scoliosis from childhood that was too small to detect during routine screening and asymptomatic, but which worsened with time.
Scoliosis Signs and Symptoms
As one of the most common types of scoliosis in adults, degenerative scoliosis typically occurs in the lumbar spine. The degree of degeneration and location varies between patients, as do the symptoms. Some patients may experience mild symptoms or none at all, while others may develop more severe issues. Visible signs of scoliosis may include:
Abnormal curvature of the spine
Difference in shoulder, waist, or hip height
Difference in the way the arms hang at either side of the body while at rest
Back height differences when bending forward
Head appears not centered with the rest of the body
Rib asymmetry as seen from the front or back
One shoulder blade looks bigger than the other
One leg appears longer than the other
Patient’s inability to stand upright
Gait dysfunction (walking pattern)
Postural changes
In addition to visible signs, patients may experience symptoms of scoliosis which are a direct result of malalignment. The back discomfort develops gradually with time. The patient may feel worse in the morning. The symptoms may improve while the patient is sitting or lying down because body weight pressure is taken off the discs, bones, and joints. The symptoms of degenerative scoliosis include:
Dull pain and stiffness in the middle or lower back area
Back pain that feels worse while standing but alleviates in other positions
Shock-like pain that radiates down through the buttocks and leg
Leg numbness, pins-and-needles tingling, or weakness
In severe scoliosis cases, symptoms may include:
Breathing difficulties (if the rib cage presses against the lungs)
Bowel, bladder, or motor dysfunction
Uncomfortable symptoms, such as pain or weakness, develop when the bones in the spine compress nearby nerves or discs. Axial back pain is felt only in the neck or back. Radicular symptoms are characterized as discomfort that extends from the back to the limbs. This may be in the form of pain, tingling, numbness, weakness, or even a loss of function.
The location of the nerves determines which limb is affected. For instance, cervical (neck) radiculopathy is commonly associated with symptoms in the shoulders, arms, and hands. Lumbar (low back) radiculopathy is linked to symptoms in the buttocks and legs and may extend into the feet.
It is important to note that the symptoms of degenerative scoliosis may be similar to other health conditions. Centers for Neurosurgery, Spine & Orthopedics (CNSO) is experienced in deciphering and treating a wide variety of spine conditions that may have similar symptoms but require different cures. Consulting a spine health specialist, such as a neurosurgeon or orthopedic spine surgeon, to receive a diagnosis is the key to determining if scoliosis or another condition is the reason for discomfort, then applying effective treatment.
Diagnosing Degenerative Scoliosis
After discussing the medical history, if degenerative scoliosis is suspected, the physician will perform a physical examination to identify the location of the pain and other symptoms. During a scoliosis exam, the physician also will evaluate the extent of spinal curvature. This is done through the following:
Adams forward bend test: With feet together and knees straight, the patient is asked to bend forward so the doctor can identify visual signs of deformity along the back or ribcage.
Scoliometer measurement: By placing a simple tool on the spine (scoliometer), the doctor will estimate the degree of curvature.
The physician also will do the following during this examination:
Observe and palpate (feel) the spine
Check the patient for neurological symptoms, such as pain, numbness, and tingling
View the patient while standing upright, with arms relaxed by their side, to identify shoulder and waist asymmetry or trunk shift
Ask the patient to lean forward or from side to side
A spinal curve of at least 10 degrees would need to be present before it would be classified as scoliosis. The degree of curvature referred to as the Cobb angle is a widely adopted standard to evaluate the severity of spinal deformity. Based on the measurement of the Cobb angle, the degree of scoliosis severity is classified as follows:
Minor asymmetry: 0 – 10 degrees
Mild scoliosis: 10 – 20 degrees
Moderate scoliosis: 20 – 40 degrees
Severe scoliosis: Over 40 degrees
Depending on the Cobb angle, as well as other salient factors, a treatment plan is formed. The neurosurgeon or orthopedic spine surgeon typically measures the degree of spinal curvature from an X-ray image.
The precision of the Cobb angle measurement is taught to neurosurgeons and orthopedic spine surgeons. No other medical specialist can perform this measurement to the same degree of reliability. If scoliosis or other spine conditions are of concern, only these types of surgeons should further evaluate the spine using magnetic resonance imaging (MRI) or a computed tomography (CT) scan. The technology of these radiologic images provides a more in-depth view of the anatomic structures and allows the surgeon to rule out, or rule in, conditions that are causing the symptoms the patient is experiencing.
Once the cause of the patient’s signs and symptoms has been identified, the CNSO physician will discuss a proposed treatment plan with the patient. The spine specialists, neurosurgeons, orthopedic spine surgeons, and pain management doctors at Centers for Neurosurgery, Spine & Orthopedics educate the patients about their condition, discuss immediate treatment options and long-term expectations, and keep patients informed about their care.
Scoliosis Treatments
In many cases, scoliosis is detected as an incidental finding that requires little or no treatment. But when symptoms do occur, the primary goal is to reduce pain and alleviate any symptoms that interfere with everyday life. As with other conditions, Centers for Neurosurgery, Spine, and Orthopedics takes a conservative approach to scoliosis. Non-surgical scoliosis treatments for mild to moderate cases may include:
Medication: Over-the-counter (OTC) medicine can help reduce pain.
Physical therapy: A customized physical therapy program can help the patient improve their posture, increase flexibility, and strengthen their abdomen and back.
Bracing: In some cases, a back brace may help prevent a curved spine from getting worse.
Epidural steroid injections: Often administered in a series over one or two weeks, epidural steroid injections can help relieve pain and enable the patient to live more comfortably.
Nerve block: If physical therapy or medications prove insufficient, a nerve block may provide temporary relief.
If the patient has already been diagnosed with scoliosis, the CNSO surgeon will compare the patient’s current Cobb angle with past exams to see whether the proposed treatments are working or if the condition is worsening. Surgical intervention typically is recommended if the curve has reached 50 degrees or more. Typically, this degree of curvature would cause significant symptoms, affecting the overall quality of life.
In extremely severe cases, the spine can reach an 80-degree curvature that causes a loss of space in the thorax, preventing the appropriate expansion of the lung on the affected side of the body. This results in breathing difficulties, including a loss of oxygenation when exercising or even at rest. If the curvature is encroaching on the left thorax and is so extreme it compresses the lung on the left side, it will also compress the heart, adding to oxygenation difficulties.
Scoliosis surgery may include:
Laminectomy: Designed to alleviate pressure, the surgeon removes a portion of one or more lamina (bony arches) during this spine surgery.
Spinal fusion surgery: This procedure helps restore vertebral alignment by removing damaged bone or discs and using bone graft to create stability.
The specialists at Centers for Neurosurgery, Spine & Orthopedics may use robotics surgery for the right candidate. Robotic surgery is highly beneficial for revision surgery and extreme deformity cases, given the distortion of normal anatomy.
After surgery, physical therapy usually is recommended to help patients regain strength and flexibility throughout recovery. The surgeon will discuss the recovery process with the patient in detail, ensuring they fully understand the objectives of the procedure and how their condition may improve as a result. They also keep the patient apprised of any instructions and particular considerations during r the recovery period.
Receive Expert Degenerative Scoliosis Care at CNSO
Centers for Neurosurgery, Spine, and Orthopedics is staffed for treating scoliosis at any point throughout the patient’s journey. The award-winning, board-certified doctors include neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, rehabilitation specialists, physiatrists, and certified physical therapists. Each physician is dedicated to providing coordinated care across the necessary specialties tailored to the patient’s needs.
CNSO has several locations throughout northern New Jersey, allowing patients to receive the care they need in a location most convenient for them. Also, CNSO provides telemedicine appointments using HIPAA-compliant technology when an in-person visit is not possible or required. Contact CSNO today to schedule an appointment for more information about degenerative scoliosis treatment options, including surgical as well as non-surgical options.
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